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General NPI Number Information
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NPI Number | 1699710145
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Entity Type | Organization
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Legal Business Name | LYDIA MATKOVICH, M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 23600 TELO AVE SUITE 210
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City | TORRANCE
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State | CA
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Zip | 90505-4035
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Country | US
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Telephone | 310-626-8055
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Fax | 310-626-8058
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Provider Business Mailing Address
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Address Line | 23600 TELO AVE SUITE 210
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City | TORRANCE
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State | CA
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Zip | 90505-4035
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Country | US
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Telephone | 310-626-8055
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Fax | 310-626-8058
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYDIA MATKOVICH
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Credential | M.D.
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Telephone | 310-626-8055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G80774
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License Number State | CA
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